A joint mission led by the World Health Organization (WHO) to assess Saudi Arabia's efforts against MERS-CoV said today that the country has made progress and is ready to take the next proactive steps, such as better surveillance in camels.

The WHO today also released new details about 4 of Saudi Arabia's recent cases, plus 2 in the United Arab Emirates (UAE). Of the 6 MERS-CoV (Middle East respiratory syndrome coronavirus) cases, 5 patients had a history of contact with camels, while 1 case involves an asymptomatic contact.

Progress and remaining challenges

The WHO joint mission to Saudi Arabia took place from Jan 11 through 14 and included visits to health and agriculture ministries, hospitals in Riyadh and Hofuf, labs, a camel research facility, and a camel slaughterhouse and market in Hofuf, according to a report posted by the WHO Eastern Mediterranean regional office.

The event marked the third recent joint MERS mission to the country. The previous one came in August in the wake of a large hospital outbreak in Riyadh.

Some of the group's goals were to observe Saudi Arabia's surveillance for the disease, its latest hospital infection and prevention protocols, case investigation capabilities, and research priorities.

The experts gave Saudi Arabia good marks for getting its MERS-CoV command center up and running, which has laid good groundwork for an effective public health response, they said. They added, however, that the system's full potential is not yet being met.

The mission found that surveillance for detecting and monitoring suspected and confirmed MERS-CoV cases has improved, now that an electronic Web-based system is up and running. They noted, though, that the systems are mainly "responsive" and that the next step would be a sentinel surveillance system to look for severe acute respiratory infections to help flag problems earlier and reduce the risk of missed cases.

Camel surveillance, however, is still in planning stages, with few resources for implementing monitoring of the disease in the animals before infections occur in humans, the team found. They also pointed out that health and agriculture ministries are collaborating more on primary case investigations, though they are still conducting their probes separately.

Hospital outbreaks have declined at health ministry hospitals, but challenges remain at other hospitals, according to the group. Lessons learned from a large outbreak at a National Guard hospital led to infection prevention and control improvements at other National Guard hospitals, but so far such experiences are being shared only within health systems, and not between them.

Saudi Arabia has set up a committee to identify and fund research priorities, but it's not clear how sharp the focus will be on epidemiologic research that can help answer key public health questions, the experts said.

For the country's next priorities to step-up the response to MERS-CoV, the joint mission group had five main recommendations. They included appointing a leader with the necessary authority to fully implement and expand the nation's strategy for controlling the disease.

The recommendations also included increasing collaboration between health and agriculture ministries, addressing research priorities flagged by earlier MERS-CoV expert groups, documenting and sharing infection prevention and control lessons, and making the control center a multisector body to deliver a coordinated, consistent approach.

Recent Saudi cases underscore camel link

In a separate report today the WHO fleshed out details about four MERS cases reported by Saudi Arabia between Dec 27 and Jan 13. All patients had a history of frequent contact with camels, and three drank raw camel milk.

All are men, ages 50 to 85, with underlying health conditions. They are from four different cities, three in western Saudi Arabia (Medina, Bisha, and Jeddah). The other is from Unaizah in the central part of the country.

Two are hospitalized in critical condition, and two are listed as stable.

One of the patients, the 85-year-old, traveled by plane to Riyadh to seek medical care after he was treated for his symptoms on an outpatient basis in Bisha.

Details of earlier UAE detections

The UAE announced two MERS cases from Abu Dhabi on Jan 14, but gave no details about the patients, one of whom died.

In a statement today the WHO said the first patient is a 73-year-old man who first got sick on Dec 27 and sought outpatient care for his symptoms. He traveled to Oman with his family on Dec 31, returning to Abu Dhabi the next day, where he was hospitalized.

The man—who has no chronic health conditions—tested positive for MERS-CoV on Jan 10. He died from his infection on Jan 25. An investigation revealed that he had frequent contact with camels and had consumed camel milk once in the 14 days before he became ill. The WHO said he had no exposure to other risk factors in the UAE or Oman during the incubation period.

The second patient is an 85-year-old woman from Abu Dhabi who is one of the man's contacts. She tested positive for the virus on Jan 13 and is being monitored in the hospital for an asymptomatic infection.

The WHO said the woman has underlying health conditions and had no exposure to other risk factors in the 14 days before MERS-CoV was detected in her samples.

Contact tracing of household and healthcare contacts is still under way, the agency said.

Since MERS-CoV was first detected in 2012, the WHO has received reports of 1,632 illnesses, at least 587 of them fatal.